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Cracks in the Armour

Strap yourselves in, we’re going to talk about vaccines. We’ll start with a crash course in how vaccines work, and then go on to address the ongoing problem with how we talk about the vaccines and the infamous “autism issue”.

A vaccine is to a disease what a crash-test dummy is to a human — it’s a mock-up, a pretender. When a crash-test dummy is run through a crash it simulates a person. It hits its body parts and gets flung about, but it doesn’t bleed or feel pain or die, because it’s only a representation that mimics the movements of a person. The specific ways in which the dummy gets thrown around or damaged by a crash enables car-designers to prepare and refine the features of their car. This ensures that when a real person gets into the same situation, precautions have been put in place to make sure the outcome is as favourable to people as possible.

A pathogen (a type of disease) is covered in molecules called antigens, giving its outside shape and function (like the shape of the limbs and body of a person) and determines how it interacts with other cells. When a vaccine is prepared, these antigens are replicated, harvested, suspended — in short, we build the shape of a disease without having the living disease itself inside it. It’s often mixed with chemicals that make the dummy flail around harder to attract more attention during the crash, as it were. Then when you’re vaccinated, the crash test dummy of a disease is rammed against your immune system.

This is of course where the metaphor reverses; a real crash test dummy is used to prepare cars so that less damage is done to the thing it represents. A vaccine is used to prepare the immune system to do more damage to the invading body, to destroy it faster and more thoroughly. Every disease has a unique shape, and your immune system’s response is shape-specific. If a disease is full of square holes that can only be taken down by plugging them with square pegs, and your body hasn’t encountered them before, then you have no square pegs. By the time your body works out that you need square pegs, and makes them, a lot of damage could have been done.

When you have the vaccine, your body learns about this disease’s shape and makes square pegs (antibodies) to fight off the disease. Afterwards some of these square pegs stick around in your immune system’s arsenal. If you then catch the real thing those antibodies get to work and, because the vaccine gave it a practice run, immediately starts fighting the infection. Crisis averted. It’s the difference between studying for an exam and walking in ready, and not studying at all and trying to work out the answers to everything from first principles. Only one of those two things will consistently work and you know which one it is.

Now that we all know how vaccines work let’s talk about vaccination risk. Some people claim that the MMR vaccine (measles, mumps, and rubella) carries serious risk of severe allergic reaction. It is true that it’s possible to have a severe allergic reaction to the MMR vaccine. It’s also true that it occurs in less than one in a million people, and that’s just the allergy, not a death. In 2012 in Australia, 58 people out of every million died on our roads. 31 people per million died from tripping over. One person per million died falling off a chair and two people per million died falling out of bed. You are more likely to die by accident just from existing inside your own house, (not even counting accidental electrocutions from appliances or heavy things falling on your head) than you are to developing an allergy to the deliberately-administered MMR vaccine. According to the WHO (World Health Organisation), 145 700 people died from measles that same year. Most of them were children under the age of 5. Thanks to vaccines, that number is down from more than half a million in 2000.

Now, not everyone can be vaccinated. Anyone who is immunocompromised due to specific chronic illnesses can’t have certain vaccinations, as well as anyone who is on immunosuppressant drugs (such as people undergoing certain cancer therapies and anyone who’s ever had an organ transplant). Pregnant women can’t have certain vaccinations at certain points in the pregnancy or at all. I say certain vaccinations because there are specific vaccinations that people in specific conditions can and can’t have, and it varies based on the condition. Suffice to say, there are people in our community who can’t have all the vaccinations that everyone else can. They rely on something called herd immunity for protection. A disease spreading is a lot like the world’s worst game of connect-the-dots. It moves from person to person (dot to dot). Some people it passes by through circumstance— they just weren’t around anyone infectious at the right time. Some people’s immune systems are more robust. It happens. Either way, a lot of people are infected. If some of those people are vaccinated, then, not only do they themselves not become infected, but they also block the path of the dot-to-dot spread. In doing so, these people prevent the spread of the disease to people who themselves cannot be vaccinated for medical reasons.

Imagine each dot below is a person. The coloured dot is someone who has caught an infectious disease.

Vaccines and Disease 1

Now we connect the dots, and a lot of people get sick. Some get lucky and it passes them by, but overall…

Vaccines and Disease 2

It’s not great for anyone involved. Now imagine some people in this population are vaccinated, the blue dots, and the yellow dots represent people who can’t be vaccinated.

Vaccines and Disease 3

The blue dots, in addition to remaining healthy themselves, also create a buffer zone through which the disease can’t travel to get to the vulnerable members of the community. This is herd immunity. It is a population’s armour against illness. When members of the community aren’t vaccinated, not only are they in danger, but they are breaking holes in the armour that protects the vulnerable people behind them, by allowing the disease to be potentially transmitted through them.

Right, that’s the science. Let’s talk about conspiracies and autism. Opponents of vaccination have in the past publicly claimed the existence of a conspiracy involving vaccination and a link to autism. Ironically, that’s not far from the truth.

In 1998, a highly-regarded medical research journal called The Lancet published a paper by then-highly-regarded doctor Andrew Wakefield. Wakefield linked the MMR vaccine to colitis and autism-spectrum disorders, and began publishing papers and holding press conferences claiming that the immunisation program was unsafe. An investigation was launched in the mid-2000s over the resulting controversy, and that’s when things get… conspiratorial. It came to light that in 1996, a solicitor named Richard Barr who was pursuing a class action case against the companies manufacturing the MMR vaccine, claimed the product didn’t work. Not that it caused any side effects, of the autistic spectrum or otherwise, but that it just didn’t work. Before his MMR-Autism publication in 1998, Andrew Wakefield received £55,000 from legal aid solicitors seeking evidence against the MMR companies and filed his own patent for a rival measles vaccine. Wakefield did not disclose the money or the patent to anyone, including the hospital he was based at, on the behalf of which he filed it (listing himself and a colleague as the inventors).

Several of the parents of the 12 children Wakefield used in his study also happened to be litigants in the pre-existing lawsuit against the MMR manufacturers.

There’s one more thing we need to talk about, and although it’s not science, it’s very important. There’s a problem with how we discuss the vaccines-autism link. It’s more blatant in those who oppose MMR vaccinations, who are openly treating the possibility of their children being autistic as wholly worse than even the possibility of their own and other children being dead. Phrases like ‘the light dying from their childrens’ eyes’ are common. It’s less overt among proponents of vaccines but the undertones are very much still there. Autistic people are being discussed like their existence is a punishment, a disease, a worst-case-scenario to be avoided. So devastatingly horrible, that allowing ones’ children to contract and spread a dangerous infection like measles, is being considered as an alternative. It’s this attitude towards autistic people however, that is an almost entirely unaddressed problem. Autistic and other non-neurotypical people lead full, productive lives as much as anyone else. They are people, with goals and needs, and desires and dreams, and the tone of the dialogue about vaccines treats their very existence like a tragedy. That needs to change. It’s not right.